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目的探讨光镜未能诊断的膜性肾病患者临床及肾脏病理的特点。方法回顾性分析1998-01~2005-03东南大学附属中大医院仅靠光镜未能诊断的9例轻型膜性肾病的临床表现及病理学特点。结果1例6岁小儿临床表现为肾病综合征;余8例45~70岁成人临床诊断为慢性肾炎或隐匿型肾炎。光镜诊断为微小病变或局灶增生性肾小球肾炎等。免疫荧光显示IgG沿肾小球基底膜散在性细颗粒状沉积。电镜可见上皮细胞下小型高密度电子致密物散在性沉积,多为膜性肾病Ⅰ、Ⅱ期病变,2例合并薄基底膜肾病。结论慢性肾炎或隐匿型肾炎中,常混有仅靠光镜难以确诊的轻型膜性肾病,进行免疫荧光及电镜检查对确定诊断至关重要。
Objective To investigate the clinical and renal pathological features of patients with membranous nephropathy who can not be diagnosed by light microscope. Methods The clinical and pathological features of 9 patients with mild membranous nephropathy who were not diagnosed by light microscope were analyzed retrospectively from 1998-01 to 2005-03 at the Affiliated Zhongda Hospital of Southeast University. Results One case of 6-year-old children had clinical manifestations of nephrotic syndrome. The remaining 8 cases aged 45-70 years were clinically diagnosed as chronic nephritis or occult nephritis. Light microscopic diagnosis of minor lesions or focal proliferative glomerulonephritis. Immunofluorescence showed that IgG was scattered finely along the glomerular basement membrane. Electron microscopy showed epithelial cells scattered small dense dense electron density deposition, mostly membranous nephropathy Ⅰ, Ⅱ lesions, 2 cases combined with thin basement membrane nephropathy. Conclusions Chronic nephritis or occult nephritis is often mixed with light membranous nephropathy, which is difficult to diagnose with light microscope only. Immunofluorescence and electron microscopy are crucial for the diagnosis.